Healthcare Provider Details

I. General information

NPI: 1710725932
Provider Name (Legal Business Name): ADAM WEST REYNOLDS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CORNERSTONE DR
MOUNT JOY PA
17552-9416
US

IV. Provider business mailing address

1001 CORNERSTONE DRIVE SUITE B
MOUNT JOY PA
17552-9416
US

V. Phone/Fax

Practice location:
  • Phone: 717-653-2929
  • Fax:
Mailing address:
  • Phone: 717-598-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030190
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: